Provider Demographics
NPI:1811149610
Name:HERMAN, FREDERICK FLINT (MD)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:FLINT
Last Name:HERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2285 CORPORATE CIR
Mailing Address - Street 2:STE 200
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7759
Mailing Address - Country:US
Mailing Address - Phone:702-360-2763
Mailing Address - Fax:949-783-2880
Practice Address - Street 1:880 SEVEN HILLS DRIVE
Practice Address - Street 2:SUITE 260
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4373
Practice Address - Country:US
Practice Address - Phone:702-990-4480
Practice Address - Fax:702-990-4808
Is Sole Proprietor?:No
Enumeration Date:2008-10-13
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN4469207K00000X, 207KA0200X
CAGS50788207KA0200X
AZ46354207KA0200X
NV13863207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6063718Medicaid
NVFA650ZMedicare PIN
CA6063718Medicaid
AZZ153845Medicare PIN